Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GOWN ULTRA IMPERV DISP SURG***

Facility

$22.00

Hospital Charge Code	1607076
Hospital Revenue Code	272
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.30

GOWN ULTRA IMPERV DISP SURG***

Facility

$22.00

Hospital Charge Code	1607076
Hospital Revenue Code	272
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$11.00
Rate for Payer: Aetna Commercial	$8.36
Rate for Payer: Aetna Medicare Advantage	$6.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.61
Rate for Payer: Cigna Commercial	$11.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.60
Rate for Payer: Oxford Commercial	$4.40
Rate for Payer: Qualcare PPO/HMO/WC	$3.30
Rate for Payer: UnitedHealthcare Commercial	$4.40
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.58

GPS MACHINE 7642

Facility

$744.00

Hospital Charge Code	270633005
Hospital Revenue Code	272
Min. Negotiated Rate	$17.93
Max. Negotiated Rate	$372.00
Rate for Payer: Aetna Commercial	$282.72
Rate for Payer: Aetna Medicare Advantage	$223.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.72
Rate for Payer: Cigna Commercial	$372.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.20
Rate for Payer: Oxford Commercial	$148.80
Rate for Payer: Qualcare PPO/HMO/WC	$111.60
Rate for Payer: UnitedHealthcare Commercial	$148.80
Rate for Payer: UnitedHealthcare Community & State	$17.93
Rate for Payer: Wellpoint Medicaid Managed Care	$19.72

GPS MACHINE 7642

Facility

$744.00

Hospital Charge Code	270633005
Hospital Revenue Code	272
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$111.60
Rate for Payer: Qualcare PPO/HMO/WC	$111.60

GPS TAP CANNULATED 5.5MM

Facility

$6,190.00

Service Code	HCPCS C1713
Hospital Charge Code	270698380
Hospital Revenue Code	278
Min. Negotiated Rate	$149.18
Max. Negotiated Rate	$3,095.00
Rate for Payer: Aetna Commercial	$2,352.20
Rate for Payer: Aetna Medicare Advantage	$1,857.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,578.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,578.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,238.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,578.45
Rate for Payer: Cigna Commercial	$3,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,497.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,361.80
Rate for Payer: Qualcare PPO/HMO/WC	$928.50
Rate for Payer: UnitedHealthcare Community & State	$149.18
Rate for Payer: Wellpoint Medicaid Managed Care	$164.03

GPS TAP CANNULATED 5.5MM

Facility

$6,190.00

Service Code	HCPCS C1713
Hospital Charge Code	270698380
Hospital Revenue Code	278
Min. Negotiated Rate	$928.50
Max. Negotiated Rate	$1,497.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,238.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,497.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,361.80
Rate for Payer: Qualcare PPO/HMO/WC	$928.50

GPS TAP CANNULATED TAP 4.5MM

Facility

$6,190.00

Service Code	HCPCS C1713
Hospital Charge Code	270698382
Hospital Revenue Code	278
Min. Negotiated Rate	$928.50
Max. Negotiated Rate	$1,497.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,238.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,497.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,361.80
Rate for Payer: Qualcare PPO/HMO/WC	$928.50

GPS TAP CANNULATED TAP 4.5MM

Facility

$6,190.00

Service Code	HCPCS C1713
Hospital Charge Code	270698382
Hospital Revenue Code	278
Min. Negotiated Rate	$149.18
Max. Negotiated Rate	$3,095.00
Rate for Payer: Aetna Commercial	$2,352.20
Rate for Payer: Aetna Medicare Advantage	$1,857.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,578.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,578.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,238.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,578.45
Rate for Payer: Cigna Commercial	$3,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,497.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,361.80
Rate for Payer: Qualcare PPO/HMO/WC	$928.50
Rate for Payer: UnitedHealthcare Community & State	$149.18
Rate for Payer: Wellpoint Medicaid Managed Care	$164.03

GRADUATED G PIN SLEEVE

Facility

$1,025.00

Hospital Charge Code	270691449
Hospital Revenue Code	272
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$512.50
Rate for Payer: Aetna Commercial	$389.50
Rate for Payer: Aetna Medicare Advantage	$307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.38
Rate for Payer: Cigna Commercial	$512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.50
Rate for Payer: Oxford Commercial	$205.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.75
Rate for Payer: UnitedHealthcare Commercial	$205.00
Rate for Payer: UnitedHealthcare Community & State	$24.70
Rate for Payer: Wellpoint Medicaid Managed Care	$27.16

GRADUATED G PIN SLEEVE

Facility

$1,025.00

Hospital Charge Code	270691449
Hospital Revenue Code	272
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$153.75
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

GRADUATE TRIANGULAR DISP 32oz

Facility

$0.82

Hospital Charge Code	270649520
Hospital Revenue Code	270
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna Commercial	$0.31
Rate for Payer: Aetna Medicare Advantage	$0.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.21
Rate for Payer: Cigna Commercial	$0.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.25
Rate for Payer: Oxford Commercial	$0.16
Rate for Payer: Qualcare PPO/HMO/WC	$0.12
Rate for Payer: UnitedHealthcare Commercial	$0.16
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.02

GRADUATE TRIANGULAR DISP 32oz

Facility

$0.82

Hospital Charge Code	270649520
Hospital Revenue Code	270
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: Qualcare PPO/HMO/WC	$0.12

GRAFIX PRIME/SQ CM

Facility

$684.00

Service Code	HCPCS Q4133
Hospital Charge Code	9808333
Hospital Revenue Code	636
Min. Negotiated Rate	$102.60
Max. Negotiated Rate	$165.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.53
Rate for Payer: Qualcare PPO/HMO/WC	$102.60

GRAFIX PRIME/SQ CM

Facility

$684.00

Service Code	HCPCS Q4133
Hospital Charge Code	9808333
Hospital Revenue Code	636
Min. Negotiated Rate	$16.48
Max. Negotiated Rate	$533.66
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.53
Rate for Payer: Qualcare PPO/HMO/WC	$102.60
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$18.13

GRAFIX PRIME/SQ CM JW

Facility

$684.00

Service Code	HCPCS Q4133JW
Hospital Charge Code	9808333W
Hospital Revenue Code	636
Min. Negotiated Rate	$16.48
Max. Negotiated Rate	$342.00
Rate for Payer: Aetna Commercial	$259.92
Rate for Payer: Aetna Medicare Advantage	$205.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.42
Rate for Payer: Cigna Commercial	$342.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.53
Rate for Payer: Qualcare PPO/HMO/WC	$102.60
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$18.13

GRAFIX PRIME/SQ CM JW

Facility

$684.00

Service Code	HCPCS Q4133JW
Hospital Charge Code	9808333W
Hospital Revenue Code	636
Min. Negotiated Rate	$102.60
Max. Negotiated Rate	$165.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.53
Rate for Payer: Qualcare PPO/HMO/WC	$102.60

GRAFT 10MM X 80 CM X 70 CM RIN

Facility

$6,845.00

Service Code	HCPCS L8670
Hospital Charge Code	270690161
Hospital Revenue Code	278
Min. Negotiated Rate	$1,026.75
Max. Negotiated Rate	$1,656.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,369.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,656.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,505.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,026.75

GRAFT 10MM X 80 CM X 70 CM RIN

Facility

$6,845.00

Service Code	HCPCS L8670
Hospital Charge Code	270690161
Hospital Revenue Code	278
Min. Negotiated Rate	$164.96
Max. Negotiated Rate	$3,422.50
Rate for Payer: Aetna Commercial	$2,601.10
Rate for Payer: Aetna Medicare Advantage	$2,053.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,745.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,745.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,369.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,745.47
Rate for Payer: Cigna Commercial	$3,422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,656.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,505.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,026.75
Rate for Payer: UnitedHealthcare Community & State	$164.96
Rate for Payer: Wellpoint Medicaid Managed Care	$181.39

GRAFT 12 MM X 30 CM RING

Facility

$5,395.00

Service Code	HCPCS L8670
Hospital Charge Code	270690160
Hospital Revenue Code	278
Min. Negotiated Rate	$130.02
Max. Negotiated Rate	$2,697.50
Rate for Payer: Aetna Commercial	$2,050.10
Rate for Payer: Aetna Medicare Advantage	$1,618.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,375.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,375.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,079.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,375.72
Rate for Payer: Cigna Commercial	$2,697.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,305.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,186.90
Rate for Payer: Qualcare PPO/HMO/WC	$809.25
Rate for Payer: UnitedHealthcare Community & State	$130.02
Rate for Payer: Wellpoint Medicaid Managed Care	$142.97

GRAFT 12 MM X 30 CM RING

Facility

$5,395.00

Service Code	HCPCS L8670
Hospital Charge Code	270690160
Hospital Revenue Code	278
Min. Negotiated Rate	$809.25
Max. Negotiated Rate	$1,305.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,079.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,305.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,186.90
Rate for Payer: Qualcare PPO/HMO/WC	$809.25

GRAFT 4X8CM

Facility

$15,640.00

Service Code	HCPCS Q4248
Hospital Charge Code	270694137
Hospital Revenue Code	278
Min. Negotiated Rate	$2,346.00
Max. Negotiated Rate	$3,784.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,128.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,784.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,440.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,346.00

GRAFT 4X8CM

Facility

$15,640.00

Service Code	HCPCS Q4248
Hospital Charge Code	270694137
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$3,784.88
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,128.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,784.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,440.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,346.00
Rate for Payer: UnitedHealthcare Community & State	$376.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$414.46

GRAFT 6MMX30CM FLIXENE

Facility

$5,499.65

Service Code	HCPCS C1768
Hospital Charge Code	270689835
Hospital Revenue Code	278
Min. Negotiated Rate	$824.95
Max. Negotiated Rate	$1,330.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,099.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,330.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,209.92
Rate for Payer: Qualcare PPO/HMO/WC	$824.95

GRAFT 6MMX30CM FLIXENE

Facility

$5,499.65

Service Code	HCPCS C1768
Hospital Charge Code	270689835
Hospital Revenue Code	278
Min. Negotiated Rate	$132.54
Max. Negotiated Rate	$2,749.82
Rate for Payer: Aetna Commercial	$2,089.87
Rate for Payer: Aetna Medicare Advantage	$1,649.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,099.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.41
Rate for Payer: Cigna Commercial	$2,749.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,330.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,209.92
Rate for Payer: Qualcare PPO/HMO/WC	$824.95
Rate for Payer: UnitedHealthcare Community & State	$132.54
Rate for Payer: Wellpoint Medicaid Managed Care	$145.74

GRAFT 6MMX38CM

Facility

$6,095.00

Hospital Charge Code	270686035
Hospital Revenue Code	278
Min. Negotiated Rate	$146.89
Max. Negotiated Rate	$3,047.50
Rate for Payer: Aetna Commercial	$2,316.10
Rate for Payer: Aetna Medicare Advantage	$1,828.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,554.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,554.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,219.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,554.22
Rate for Payer: Cigna Commercial	$3,047.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,474.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,340.90
Rate for Payer: Qualcare PPO/HMO/WC	$914.25
Rate for Payer: UnitedHealthcare Community & State	$146.89
Rate for Payer: Wellpoint Medicaid Managed Care	$161.52

Know your out-of-pocket cost for care.

All Charges